[CIS PIDD] [cis-pidd] 79yo with lymphopenia-associated mucositis

Mon Aug 15 06:27:06 EDT 2016

Hi Joe

agree fully with James. Would not investigate the lymphopenia per se further.

Bodo's suggestions on the cause of mucositis are great also from an adult specialist's point of view.

Lymphopenia and recurrent EM is often - like Bodo suggests - caused by infection like flu + drug taken "against" the flu, often some over the counter flu "medicine" or NSAID. Seen recurrent EM in mycoplasma as well. 

If the patient has mucositis once a year every summer, I would however also consider herpes-associated erythema multiforme  (HAEM) of mucosal surfaces (incited by increased exposure to sunshine, HSV not there anymore and testing useless, has been clinically or subclinically active 2-8 weeks prior, causes  appr. 90% of recurrent EM, responds to summertime prophylaxis, but HSVAb need to be + in serum of course) as well as wonder if acquired cyclic neutropenia could be causing the aphthous demise (especially if other autoimmunity). CBC 3x/w for 6 weeks then...

Has a dermatologist seen the mucositis, is it EM -like?

Mikko

oyl Mikko Seppänen
Harvinaissairauksien yksikkö (HAKE), HUS

Mikko Seppänen, MD, PhD, Associate professor 
Specialist in Internal Medicine and Infectious Diseases
Head, Rare Disease Center, Helsinki University Hospital (HUH)
Children's Hospital, P.O.Box 280
FI-00029 HUS
FINLAND
&
Senior Consultant (PIDD)
Adult Immunodeficiency Unit
Inflammation Center, HUH

phone +358 9 47180201
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Lähettäjä: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org] 
Lähetetty: 3. elokuuta 2016 22:28
Vastaanottaja: CIS-PIDD <cis-pidd at lyris.dundee.net>
Aihe: Re: [cis-pidd] 79yo with lymphopenia-associated mucositis

Joe

I think lymphopenia during illness is not uncommon. It's more important to see the counts between these out breaks. From reading flow I've seen many infected/inflamed kids with bad looking flow that reverses once they have improved.

Anecdotal I know....but that's what we see. Would be interested if other see the same thing

Best

James

Sent from my iPhone

On Aug 3, 2016, at 2:02 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:

Drug induced?
Yours, Bodo

****************************************
Univ.-Prof. Dr. med. B. Grimbacher

Scientific-Director
CCI-Center for Chronic Immunodeficiency
UNIVERSIT?TSKLINIKUM FREIBURG
Tel.: 0761 270-77731  Fax: -77744
Breisacherstra?e 115, 79106 Freiburg
bodo.grimbacher at uniklinik-freiburg.de<mailto:bodo.grimbacher at uniklinik-freiburg.de>
www.uniklinik-freiburg.de/cci<http://www.uniklinik-freiburg.de/cci>

and

Consultant Immunologist
Institute of Immunity & Transplantation
Dept of Immunology
Royal Free Hospital
UNIVERSITY COLLEGE LONDON
Pond Street
London NW3 2QG
b.grimbacher at ucl.ac.uk<mailto:b.grimbacher at ucl.ac.uk>
www.centreforimmunodeficiency.com<http://www.centreforimmunodeficiency.com>

Von: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Antworten an: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Datum: Wednesday 3 August 2016 16:28
An: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Betreff: [cis-pidd] 79yo with lymphopenia-associated mucositis

Colleagues:

I was asked by an 'adult' ID physician about a 79yo man.  The patient is generally healthy.  However, once a year over the past 3 years he developed his 'annual' URI that was associated with HSV-negative oral mucositis.  During his latest episode his absolute lymphocyte count was 613/mcL and this resulted in T-lymphopenia.  B-cells and NK cell numbers were maintained.

Two months prior to this episode his lymphocyte count was 2219 on routine CBC.  Several weeks following resolution of the mucositis both lymphocyte count and subset analysis were normal.

Has anyone seen this process?  Any insights would be much appreciated.

Joe Church, MD
Children's Hospital Los Angeles

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